Using parasternal intercostal muscle thickening to help decide when to stop mechanical ventilation

Parasternal Intercostal Muscle Thickening as an Additive Weaning Criterion to Minimize Re-intubation Rate: a Randomized Controlled Trial

This trial will test whether adding a bedside ultrasound measurement of parasternal intercostal muscle thickening helps doctors decide when to take critically ill patients off mechanical ventilation to reduce reintubation.

Quick facts

• Phase: NA
• Study type: Interventional
• Enrollment: 200 (estimated)
• Ages: 18 Years to 65 Years
• Sex: All
• Sponsor: Cairo University (other)
• Locations: 1 site (Cairo, Giza Governorate)
• Trial ID: NCT07143695 on ClinicalTrials.gov

What this trial studies

Critically ill patients who have been mechanically ventilated for 24 hours or more and are undergoing their first spontaneous breathing trial will be enrolled at Cairo University. Participants will receive bedside ultrasound measurement of the parasternal intercostal thickening fraction, with one group having that measurement used as an added weaning criterion and a control group receiving a sham measurement. The study will compare reintubation rates after extubation and track ventilation duration and related complications. The interventional design tests whether the added muscle-based criterion improves decisions about liberation from mechanical ventilation.

Who should consider this trial

Good fit: Ideal candidates are critically ill adults mechanically ventilated for at least 24 hours who are undergoing their first spontaneous breathing trial and who can tolerate ultrasound assessment and do not have a tracheostomy.

Not a fit: Patients who are tracheostomized, have neuromuscular disorders, have poor ultrasound windows, or who refuse participation are unlikely to benefit from this intervention.

Why it matters

Potential benefit: If successful, this approach could reduce unnecessary prolonged ventilation and lower reintubation rates and their complications.

How similar studies have performed: Prior ultrasound studies of respiratory muscles such as diaphragm thickening have shown promise for weaning decisions, but using parasternal intercostal thickening as an additive weaning criterion is relatively novel and not yet definitively proven.

Eligibility criteria

Inclusion Criteria:

* critically ill patient mechanically ventilated for 24 hours or more first spontaneous breathing trial

Exclusion Criteria:

* patient refusal difficult ultrasound views tracheostomized patient neuromuscular disorders

Where this trial is running

Cairo, Giza Governorate

• Cairo University — Cairo, Giza Governorate, Egypt (RECRUITING)

Study contacts

• Study coordinator: Cairo university

Conditions: Critically Ill, Weaning, re-intubation, mechanical ventilation